Hyder Ayaz
Perspect Biol Med. 2018;61(4):572-583. doi: 10.1353/pbm.2018.0066.
This article traces the emergence of lean principles in genomics research and connects this new way of doing science with many of the current pitfalls of precision medicine in its attempts at improving population health outcomes. Precision medicine has a history of public funding, yet the benefits in clinical settings are very slowly being realized due to a variety of factors, such as uncertainty regarding relevant treatments after identifying disease risk, lack of cost-effectiveness studies for general population-level interventions, and letting a culture of "over promise and under deliver" permeate some areas of genomics research. The article concludes with insights into the challenges and opportunities that will need careful consideration and consultation with the wider society in order to decide whether to turn off the "tap" for investment of public funds in research on genomics and other "omics." Ultimately, this article argues for a moderate course correction in how public funds are invested to truly improve the health of all of us, and not just some of us.
本文追溯了精益原则在基因组学研究中的出现,并将这种新的科学研究方式与精准医学目前在改善人群健康结果方面的诸多陷阱联系起来。精准医学有公共资金投入的历史,但由于多种因素,临床环境中的益处正缓慢显现,比如在确定疾病风险后相关治疗的不确定性、缺乏针对一般人群层面干预措施的成本效益研究,以及让“过度承诺而兑现不足”的文化渗透到基因组学研究的某些领域。文章最后深入探讨了一些挑战和机遇,这些需要仔细考量并与更广泛的社会进行协商,以决定是否停止对基因组学及其他“组学”研究的公共资金投入。最终,本文主张对公共资金的投资方式进行适度的方向调整,以真正改善所有人而非部分人的健康状况。